ACA Likely to Deliver Bigger Bang in Rural Areas

WASHINGTON -- The rural uninsured may reap a bigger benefit from the Affordable Care Act than their city-dwelling counterparts, which prompted health policy experts to call for a ramped-up campaign to publicize ACA in rural communities.

More rural residents than urban dwellers (10.7% versus 9.6%) can receive tax subsidies under the ACA to purchase private insurance and more uninsured are eligible for an expanded Medicaid program (9.9% versus 8.5%), Keith Mueller, PhD, director of the Rural Policy Research Institute's Center for Rural Health Policy Analysis in Iowa City, said.

"On a per person basis, we have the potential for more rural folks to benefit from this expansion than their urban counterparts," Tom Morris, director of the Office of Rural Health Policy at the Health Resources and Services Administration, said. "The next couple of months are going to be critical in terms of getting the word out."

However, a few obstacles stand in the way of getting those people signed up for either Medicaid or insurance subsidies, panelists at the briefing said.

For example, 30% of New Mexicans who were eligible for Medicaid even before the ACA still are not enrolled because there are barriers to doing so, Art Kaufman, MD, vice chancellor for community health sciences at the University of New Mexico Health Sciences Center in Albuquerque, said.

"You've heard of suppression of votes. There's also suppression of getting people enrolled," Kaufman said. "There are so many ways [to suppress enrollment] even a state that has accepted Medicaid [expansion] can slow the process."

One of the main obstacles facing the Obama administration and its advocates in their attempts to reach rural residents to tell them about expanded benefits under the ACA is political resistance to "Obamacare" in many states with large rural populations.

Their state leaders have been less willing to back programs that even would enroll or educate the public on ACA programs.

"The more we can start calling these products something else besides Obamacare, the ACA, or whatever ... the better off we're going to be," Lisa Miller, former member of the Maine House of Representatives, said.

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